Impacted Wisdom Teeth: Should They Always Be Extracted? Diagnosis, Treatment, and the Correct Intervention Process

One of the most commonly asked questions in oral and dental health is whether impacted wisdom teeth always need to be extracted. The wisdom tooth, also known as the third molar, typically emerges between the ages of 17 and 25. However, in some individuals, these teeth fail to erupt properly and remain embedded in the bone or the gum. This condition is referred to as "impacted wisdom teeth." While impacted wisdom teeth can often remain asymptomatic, in some cases, they may cause pain, infection, jaw misalignment, and damage to surrounding teeth, leading to serious complications. However, the mere presence of an impacted tooth does not automatically mean it should be extracted. The decision should be based on the tooth's position, the mouth's structure, the damage it causes to surrounding tissues, and the patient's overall oral health.

In individuals with a narrow jaw, there may not be enough space for the wisdom tooth to emerge. In this case, the tooth may either fail to erupt or emerge at an angle, pressing against the second molar. This pressure can lead to pain, dental misalignment, gum problems, and orthodontic issues. In patients who have previously undergone orthodontic treatment, impacted wisdom teeth can disrupt the alignment of other teeth, risking the effectiveness of the treatment. In such cases, extraction of the impacted wisdom tooth may be recommended. However, in some situations, the impacted wisdom tooth may lie completely horizontally within the bone, and if it does not cause damage to surrounding tissues, extraction may not be necessary. An impacted wisdom tooth that does not cause any pathology, as determined by clinical and radiographic examinations, may remain in the mouth for many years and can be monitored with regular check-ups.

The main intervention for impacted wisdom teeth is necessary when signs of infection are present. Symptoms such as swelling, redness, difficulty opening the mouth, enlargement of submandibular lymph nodes, bad breath, headaches, and throat pain indicate the presence of infection around the impacted tooth. In such cases, antibiotic treatment is initially administered, and once the infection is under control, extraction is planned. In some cases, the impacted tooth may put pressure on the root of the second molar, causing damage to the healthy tooth. If complications such as cavities or root resorption (decay of the tooth root) are present, extraction of the impacted tooth becomes inevitable. Additionally, more serious pathological conditions such as cysts or tumors may develop due to the impacted tooth. In such cases, surgical intervention is unavoidable.

However, before extracting any impacted wisdom tooth, a thorough examination and panoramic X-ray evaluation must be performed. The tooth's position within the jawbone, its proximity to surrounding nerve tissues, and its relationship to neighboring teeth should be analyzed. Particularly for wisdom teeth located in the lower jaw, they may be very close to the mandibular nerve. If this nerve is damaged, complications such as permanent numbness, tingling, or loss of sensation can occur. For this reason, extraction of lower wisdom teeth requires extra caution and surgical expertise. If extraction is necessary, the procedure is typically performed under local anesthesia by oral surgeons. While teeth in simple positions can be extracted using standard techniques, impacted teeth that are completely embedded in the bone may require surgical incisions and bone removal procedures.

Impacted wisdom teeth are not always doomed to be extracted. After a thorough examination by the dentist, it may be decided that some teeth can remain in the mouth. In such cases, the tooth must be regularly monitored. As long as there is no pain, swelling, chewing difficulty, or gum issues, no intervention is necessary. However, regular check-ups at a young age can help prevent potential problems before they arise. If potential issues with the impacted tooth are identified, early extraction is easier and less complicated. As a person ages, the bone structure becomes denser, and healing times become longer. Therefore, the timing of intervention is crucial for the success of the treatment.

In conclusion, the decision regarding impacted wisdom teeth is entirely individual and depends on each patient's oral structure, tooth position, and complaints. The mere presence of an impacted tooth is not sufficient reason for extraction. If the surrounding tissues are healthy, there are no orthodontic issues, and there is no risk of infection, the tooth may remain in the mouth without any problems. However, if there is inflammation, pain, swelling, damage to neighboring teeth, or orthodontic disruption, early surgical intervention may be recommended. The best decision regarding impacted wisdom teeth should be made after a detailed assessment by a dentist or oral and maxillofacial surgeon. Therefore, regular dental check-ups are essential to maintain oral health and prevent potential issues. Early diagnosis and proper planning in the treatment of impacted teeth are key to ensuring a healthy mouth and a high quality of life in the long run.